Without insurance, I’d pay less for an office visit if I simply paid cash and told my doctor I was uninsured. But if I’m in a ‘preferred provider network’ then why can’t I get a break if I pay in cash at the time of service? If I’m paying in full, there’s no administrative costs that go into collecting the payment. Couldn’t I get a discount for that amount?
August 2, 2006
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I spoke to a friend yesterday who came to me asking for help. Her husband had chronic cervical spine pain and went to an orthopedists office for two epidural injection. The injections were to the same disc level but on opposite sides with injections performed the same day. The procedures were performed under fluoroscopy in the doctor’s surgery center attached to the office. My friend’s husband had heard good things about this doctor and chose to go ‘out of network’ to see this specialist. What he didn’t realize was that he was now responsible for the entire bill. and the total bill was $8000. I kid you not, $4000 per injection.
So the question is really two part. (1) what’s the real value of the service and (2) what does he really owe. If he had gone ‘in network’ his insurance would have covered the charges in a pre negotiated contract. But now since he went out of network, his insurance is going to cover less of the charge and he’s going to be liable for the entire charge. And the worst of it is that he had no idea of what the charge was going into the office. So in essence, the relationship here is that you go to the doc and he/she charges you whatever they want and then expect you to be liable for that charge.
Is there something wrong with this picture?
My suggestion was that he research Medicare usual and allowable charges (UCR) for the CPT codes. And then go to the office and negotiate a cash payment. Might work, and at least he has a reference for what the rest of the industry is getting paid. And by the way, the UCR for Medicare was $475, not $4000.
Good news is that he feels much better. So certainly, there is value to the service.
Moral of the story is that you need to do your homework before signing on to the service.
Jeff
Comment by Jeff — August 4, 2006 @ 5:31 pm
Here’s a great article on the transparency of pricing of health care services from the Chicago Tribune.
Jeff
Comment by Jeff — August 10, 2006 @ 8:58 pm